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South Carolina rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $6,025.60 / $16,595.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,715.35 / $6,606.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $125.89 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13